Comparison of long‐term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE‐CRUSH II registry

Abstract Background Double kissing (DK)‐crush and T‐stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long‐term outcomes of DK‐crush and TAP techniques in patients with complex bifurcation lesions. Methods A total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single‐center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in‐hospital or long‐term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven‐target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias. Results The initial management strategy was DK‐crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK‐crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK‐crush group compared to the TAP group. The long‐term TLF was significantly higher in the TAP group compared to the DK‐crush group (unadjusted HR: 1.974, [95% CI: 1.044–3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232–5.061], p = 0.011). Conclusion The present study showed that the DK‐crush technique of bifurcation treatment was associated with lower long‐term TLF and TLR rates compared to the TAP technique.